Transforaminal Epidural/Selective Nerve Root Block
This technique represents a very precise, x-ray controlled injection of a small volume of medication into the anterior epidural space and the exiting spinal nerve sheath. It is a useful technique for precisely diagnosing the specific level of the pain generation, as well as treating pain of disc or spinal nerve origin. When making a diagnosis, the suspected areas of pain generation are located on x-ray and a small needle is placed into the neural foramen (the spinal opening through which the spinal nerve exits). An X-ray machine (fluoroscope) is used to observe/confirm the appropriate spinal nerve level after a small amount of contrast is injected. The resulting contrast spread, called an epidurogram, can give valuable information regarding the anatomy at the injected level. Additionally, the patient may feel a paresthesia, or tingling sensation, in the area of the body supplied by the injected spinal nerve. Following this, a small amount of local anesthetic and steroid is injected to decrease inflammation and thereby providing analgesia and allowing for reduced pain and increased function. Several studies have confirmed that transforaminal epidural steroid injections are highly effective in treating radicular pain and can prevent surgery in two-thirds of patients.
